| Part one:The linked color imaging based endoscopic grading of gastric intestinal metaplasia and its correlation with pathological grading systemObjective:It has been found that the pathological changes of gastric intestinal metaplasia(GIM)under linked color imaging(LCI)gastroscope showed lavender purple,also known as ’purple in mist’(PIM),which can be used to diagnose intestinal metaplasia under endoscopy.In this study,we proposed a linked color imaging based endoscopic grading of gastric intestinal metaplasia(LCI-EGGIM),and compared it with the currently recognized pathological grading system of gastric intestinal metaplasia which was called operative link for gastric intestinal metaplasia assessment(OLGIM),and calculated the best cut-off value for predicting LCI-EGGIM in OLGIM Ⅲ/Ⅳ stage patients.Methods:LCI was performed for the entire mucosa,and images of five areas were recorded from the lesser and greater curvatures of the antrum and corpus,and the incisura.According to the PIM range of LCI,the total score of intestinal metaplasia was calculated.If there is PIM in each site under LCI(i.e.the site score is 1-2),the PIM mucosa will be targeted for biopsy.If there is no obvious PIM in this site(i.e.the site score is 0),random biopsy will be performed in this site according to the biopsy requirements of new Sydney system,and the biopsy will be sent for histopathological examination to obtain the OLGIM stages of each patient.LCI-EGGIM and OLGIM were compared,and the correlation between them was analyzed statistically to determine the best critical value for predicting LCI-EGGIM score of OLGIM Ⅲ/Ⅳ stage patients.Results:GIM was staged as LCI-EGGIM 0,1-4,and 5-10 in 130,82and 65 patients,GIM was staged as OLGIM 0,Ⅰ,/Ⅱ and Ⅲ/Ⅳ in 136,107,and 34 patients,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of PIM under LCI were 91.49%,90.74%,90.97%,81.89%and 95.88%,respectively.For OLGIM Ⅲ/Ⅳ diagnosis,the area under receiver operating curve was 0.949(95%CI 0.916-0.972).EGGIM≥5,with sensitivity and specificity of 94.12%(95%CI 80.3%-99.3%)and 86.42%(95%CI 81.5%-90.5%),respectively,was determined the best cut-off value for identifying OLGIM Ⅲ/Ⅳpatients.Conclusion:LCI-EGGIM can be used to evaluate the degree of GIM under gastroscope,and there is a significant correlation between LCI-EGGIM and OLGIM.LCI-EGGIM≥5 is the best critical value to predict OLGIM Ⅲ/Ⅳ stage patients.Part two:The value of The linked color imaging based endoscopic grading of gastric intestinal metaplasia in the assessment of the risk of gastric cancerObjective:To evaluate the value of LCI-EGGIM and OLGIM in risk stratification of early gastric cancer(EGC),and to compare the efficacy of them.Methods:This study was conducted in 81 EGC patients who underwent endoscopic submucosal dissection(ESD).Each EGC patient included in the study,the age and gender matched patients without early gastric cancer were randomly selected within the age range of 3 years.Finally,81 pairs of patients were obtained,and the general situation and EGC related risk factors of all patients were recorded.Both groups completed LCI-EGGIM and OLGIM as required,and the risk factors of EGC were analyzed statistically.Results:In EGC group,LCI-EGGIM≥5 was significantly higher than that in control group(58.02%vs 12.35%,P<0.001).In EGC group,OLGIM Ⅲ/Ⅳ was significantly more than that in control group(56.79%vs 7.41%,P<0.001).In multivariate analysis,OLGIM Ⅲ/Ⅳ(AOR 29.74,95%CI 7.49-117.94)and LCI-EGGIM≥5(AOR 12.33,95%CI 3.71-41.02)were significantly associated with EGC.There was no significant difference in AUC of ROC curve between LCI-EGGIM and OLGIM in predicting the risk of early gastric cancer(0.74 and 0.76,P=0.1116).Conclusion:OLGIM and LCI-EGGIM can be used to predict the risk stratification of EGC in patients with GIM.OLGIM and LCI-EGGIM score have the same value in predicting the risk stratification of EGC in patients with GIM. |
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